•  
  •  

WHY ATTEMPTED SUICIDE?

In contrast to the large number of suicidal individuals who do not seek professional help, those admitted to emergency departments following a suicide attempt enter the health care system, and can thus be taken into follow-up care. Attempted suicide is therefore a key focus in clinical suicide prevention (1).

Attempted suicide is one of the most frequent reasons for emergency hospital admissions (2). In the US, it is assumed that each year 1.4 million attempt suicide (SAMSHA 2015). Repetition of attempted suicide is common: Approximately 15%–25% of people who self-harm will repeat an episode within one year, and 20%–28% over the next few years (3, 4). The suicide risk increases with each attempt and remains high over decades (5).

Furthermore, people with a history of attempted suicide have a 40 to 60 times increased risk of suicide compared to the general population (6), with 1-3% of suicides occurring within one year of the attempt, 3.9% within 5 years, and, for individuals with a history of multiple attempts, 4.7% within 10-15 years (4, 5).

Routine hospital admissions generally have little effect on future suicidal behaviour (7). However, there is evidence that specific psychological interventions are effective in reducing suicidal behaviour (8, 9).

PROBLEMS IN CLINICAL PRACTICE

Emergency Departments (EDs) are prime locations for identifying individuals at high risk of suicide and for making lifesaving interventions (10). After attempted suicide, medical stabilization and psychosocial assessment, most patients are discharged to outpatients, or – too often – with no follow-up care at all. Generally, EDs are underused in getting self-harm patients involved in follow-up treatment (11).

Health care staff in EDs as well as psychiatric institutions often find it difficult to work with self-harm patients, considering the frequent repetition of self-harm, frustrating and difficult patient behaviour, and communication difficulties. “Additional staff training in working with self-harm patients could have the potential to increase staff confidence and attitudes and enhance patient care” (12).

In follow-up treatment after a suicide attempt, “no show” and dropout rates are alarmingly high. Some 50% do not attend the first appointment, and of those who do attend, up to 60% do not continue with treatment after one week. (11).

Patients receiving specialized treatments are more likely to complete the full course of therapy than those who receive usual ED care (13). Considering the limited resources for follow-up treatment of the large population of patients who attempt suicide, there is a clear need for brief and focused treatments for these patients (1).

“The ED is a critical link to outpatient care in the chain of suicide prevention.”
(Larkin & Beautrais, 2010)
“Additional staff training in working with self-harm patients could have the potential to increase staff confidence and attitudes and enhance patient care.“
(Gibb, Beautrais, Surgenor, 2010)
“Ensure that people who have attempted suicide can get effective interventions to prevent further attempts.“
(Aspirational Goal Nr. 6, Research Agenda of the National Action Alliance of Suicide Prevention, 2014)
“Early engagement and therapeutic intervention based on psychological theories of suicidal behaviour, sustained in follow-up contacts, may be particularly beneficial“
(McCabe, Garside, Backhouse, Xanthopoulou, 2018)
© ASSIP.CH 2019